Customer Service Advocate

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers. We have operated in the Arizona market for more than 14 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost. AZPC's Customer service Advocate acts as a liaison between members, providers, our internal departments and the Health Plans who we partner with to ensure our members are receiving the best possible healthcare services. As a Customer Service Advocate, you are the primary internal contact for our organization; you will establish and maintain relationships and support for members and providers to ensure their needs are met completely, promptly and professionally. Our Member Advocates provide support to all customers, identify and remove barriers, educate and guide members through our care delivery model, and provider network. As an Advocate, you will convey to our members a sense of caring knowledge and expertise in our services. You are in a unique position to influence a positive customer experience by providing information & solving issues while ensuring a high level of member satisfaction. The Customer Service Advocate is critical to the overall success of the company. Health care providers and patients value timely and accurate responses to their questions. AZPC delivers this value by engaging top-notch representatives. We strive to answer 80% of calls in 30 seconds or less and provide accurate answers to inquiries on the first call. The position is task oriented, required someone with good relationship and research skills, attention to detail, strong communication, and time management. Customer Service Advocates demonstrates personal initiative, team spirit, and service orientation while maintaining a positive, caring, professional attitude. POSITION DUTIES & RESPONSIBILITES Serves as an advocate for members, to assist with inquiries regarding referrals and prior authorizations, AZPC's provider network, appeals and grievance processes by addressing questions or concerns. Processes complaints and research issues; working with appropriate internal and external partners. Respond to Customer inquiries via telephone (and written correspondence) with focus on resolving issues on the first call, utilizing reference materials and available resources to identify the status of the issue and provide appropriate response to the caller. Support outbound calls and call campaigns as needed. Provide assistance to health care professionals, vendors, and AZPC Health Plan partners; verify patient eligibility, provide claim payment and referrals/prior authorization status, and collaborate with our partners (including but not limited to) other departments, Health Plans, and provider network to facilitate the member experience. Deliver information and answer questions in a positive, conversational and compassionate manner while excelling in customer service to contribute to a culture of going above and beyond to ensure a high-level member satisfaction. Gather necessary, relevant information and complete documentation necessary to track issues and inquiries into Customer Service application. Provide follow-up contact with members and providers to ensure timely resolution and customer satisfaction. Assist members and/or providers regarding website information and navigation. Identify trends related to incoming or outgoing calls to support excellent customer service, quality improvement, call reduction and issue resolution, escalating issues to management as deemed appropriate. Consistently achieve department goals established for the position in the areas of quality, performance, efficiency, first call resolution and attendance; essential to the member and provider experience. Strong listening skills are essential; to give full attention to understanding the customer needs. Critical thinking, problem solving, decision-making; necessary to ensure the best solutions and resolution to customer problems and strong communication in line with member's communication preferences. Act as a subject matter expert – Knowledgeable in procedures, protocols, benefits, services, and resources to resolve member issues and inquiries. Real-time documentation; enter member demographics and information with accuracy and attention to detail. Strong computer skills; ability to multi-task and navigate multiple Windows applications while communicating and documenting accurate, relevant information. Perform other duties as assigned, including but not limited to, special projects, outreach initiatives, administrative duties, receptionist desk support, etc. EDUCATION, TRAINING AND EXPERIENCE High school diploma or equivalent – Some college preferred. Prior experience in customer service Knowledge of Medicare, managed care systems, and medical terminology preferred. Excellent written and oral communication skills. Ability to interact with providers and patient in a professional manner with a strong commitment to positively representing the company. Ability to function in a high stress environment. Familiarity with computer and Windows PC applications and the ability to multi-task and navigate a computer while on the phone. This role requires FT in-office presence for the first 60 days of employment. Hybrid schedule available after initial training period. #J-18808-Ljbffr